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By Athena Mandros

Over the past few weeks, we’ve been focused on the social determinants of health – and their link to health outcomes and spending (Poverty Really Does Matter When It Comes To Health Care Spending and Helping Consumers With Food Insecurity: What Services Are Available?). The effects of poverty and the need for income assistance are an important part of this discussion. The OPEN MINDS Market Intelligence report issued last week, What Income Assistance Is Available To Consumers Through TANF & How Does It Vary By State?: An OPEN MINDS Market Intelligence Report, focused on TANF, which provides income assistance through cash and non-cash benefits to mostly able-bodied families with children. This program is relatively small and provides benefits to about 1.5 million households at any point in time (see Helping Low-Income Consumers Access The Resources They Need).

The larger source of income assistance in the United States is through the Supplemental Security Income (SSI) program, which provides monthly cash benefits to low-income individuals who are aged, blind, or disabled. The SSI program provides monthly cash benefits to about 8.3 million individuals a month.

The SSI program is often confused with the Social Security Disability Insurance (SSDI) program, which provides benefits to about 10.2 million individuals. This confusion is understandable – both are federal programs that provide income assistance to individuals who are disabled. Although the programs provide the same benefit, they are separate programs. There are a few key differences that are important to understand. Both programs are also tied to eligibility for health care coverage (SSI to Medicaid eligibility and SSDI to Medicare eligibility), which amplifies the confusion – and makes knowing the difference between the programs particularly important for health care provider organizations.

First, what are the similarities? Both programs provide cash benefits to individuals who meet the Social Security Administration’s disability determination criteria and cannot work due to their disability.

This is where the similarities end – there are three main differences between the programs:

  1. Work requirements
  2. Income requirements
  3. Amount of cash benefit

Work Requirements – To qualify for the SSI program, there are no work requirements and an individual’s employment history has no effect on the benefits received. To qualify for SSDI, an individual must have earned a minimum amount of work credits. Individuals receive one work credit for every $1,260 in earnings that are subject to Social Security taxes. A maximum of four credits can be earned each year. The older a person is when they apply for benefits, the more work credits they must have earned. For example, an individual who applies for a disability and is under the age of 24 must only earn six work credits. Individuals between the ages of 24 and 31 must earn credits for half the time worked between age 24 and 31. Individuals over the age of 31 must earn upwards of 20 credits. Disabled individuals with no work credits do not qualify for SSDI and, therefore, do not qualify for Medicare until they are 65.

Income requirements – To qualify for SSI, an individual must have income (minus deductions) that is less than the maximum SSI benefit. In 2016, the benefit was set at $733 for an individual and $1,100 for a couple (for more detailed income requirements, see What Are The Supplemental Security Income (SSI) Program Eligibility Requirements & Benefits? An OPEN MINDS Market Intelligence Report). SSDI does not take into account a person’s assets or income when determining their eligibility for the program. To qualify for SSDI, an individual must be totally disabled, meet the work requirements listed above, and be under full retirement age (see Annual Statistical Report on the Social Security Disability Insurance Program, 2014).

Amount of Cash Benefit – Once an individual has qualified for SSI, their maximum monthly benefit is $733, or $733 minus any income. Once an individual has qualified for SSDI, their maximum monthly benefit is determined by their average lifetime earnings.

SSI is the program of last resort – meaning that an individual must apply for all other income assistance programs, including SSDI before applying for SSI. Individuals can receive benefits from both programs, but their SSDI payment plus any other income must be below the SSI limit of $733. Whether an individual receives payments from one or both programs has a direct effect on their health care coverage:

  • Individuals who receive SSDI payments only: Eligible for Medicare after a 24-month waiting period. Some states provide Medicaid coverage during the waiting period.
  • Individuals under the age of 65 and receive SSI payments only: Automatically eligible for Medicaid in most states. They will not be eligible for Medicare until they are 65.
  • Individuals receiving SSDI payments and SSI payments: Eligible for Medicare and Medicaid (in most states), meaning they are dual eligible beneficiaries.

Understanding how your consumers derive their health coverage, especially those who are dual eligible or receiving SSI benefits, can be an important indicator of whether these individuals need help accessing additional social services such as housing or nutrition assistance. To learn how to connect your consumers to these services see: How Are Permanent Supportive Housing Initiatives Funded?: An OPEN MINDS Market Intelligence Report and What Services Are Available For Nutrition Assistance & What Is U.S. Spending On Those Programs?: An OPEN MINDS Market Intelligence Report

For more detail on the SSI program (and a helpful chart outlining the differences between the SSI and SSDI programs) be sure to check out: What Are The Supplemental Security Income (SSI) Program Eligibility Requirements & Benefits? An OPEN MINDS Market Intelligence Report. This report explores the SSI program in depth – including program spending, eligibility requirements, and benefits – and answers the following questions:

  1. What Is The Supplemental Security Income (SSI) Program?
  2. What Does The U.S. Spend On The SSI Program & How Does It Compare To Other Income Assistance Programs?
  3. What Is The Average SSI Benefit?
  4. How Is Eligibility For SSI Determined?
  5. What Are The Characteristics Of SSI Recipients & How Have They Changed Over Time?
  6. How Does SSI Incentivize Individuals To Work?

Stay tuned tomorrow, when I’ll go into more detail about the SSI program spending and benefits.


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